Commentary on Cipriani et al.: Effect of Previous Abdominal Surgery on Laparoscopic Liver Resection: Analysis of Feasibility and Risk Factors for Conversion (J Laparoendosc Adv Surg Tech A 2018;28:785–791)

ABSTRACT Introduction: The introduction of laparoscopic surgery has changed abdominal surgery. We evaluated the evolution and changing trends associated with adoption of laparoscopic liver resection (LLR) and the experience of a surgeon without prior LLR experience. Methods: A retrospective review of 310 patients who underwent LLR performed by a single surgeon from 2011 to 2020 was conducted. Exclusion criteria were patients who underwent laparoscopic liver surgeries such as excision biopsy, local ablation, drainage of abscesses and deroofing of liver cysts. There were 300 cases and the cohort was divided into 5 groups of 60 patients. Results: There were 288 patients who underwent a totally minimally invasive approach, including 28 robotic-assisted procedures. Open conversion occurred for 13 (4.3%) patients; the conversion rate decreased significantly from 10% in the initial period to 3.3% subsequently. There were 83 (27.7%) major resections and 131 (43.7%) resections were performed for tumours in the difficult posterosuperior location. There were 152 (50.7%) patients with previous abdominal surgery, including 52 (17.3%) repeat liver resections for recurrent tumours, and 60 patients had other concomitant operations. According to the Iwate criteria, 135 (44.7%) were graded as high/expert difficulty. Major morbidity (>grade 3a) occurred in 12 (4.0%) patients and there was no 30-day mortality. Comparison across the 5 patient groups demonstrated a significant trend towards older patients, higher American Society of Anesthesiologists (ASA) score, increasing frequency of LLR with previous abdominal surgery, increasing frequency of portal hypertension and huge tumours, decreasing blood loss and decreasing transfusion rate across the study period. Surgeon experience (≤60 cases) and Institut Mutualiste Montsouris (IMM) high grade resections were independent predictors of open conversion. Open conversion was associated with worse perioperative outcomes such as increased blood loss, transfusion rate, morbidity and length of stay. Conclusion: LLR can be safely adopted for resections of all difficulty grades, including major resections and for tumours located in the difficult posterosuperior segments, with a low open conversion rate. Keywords: Laparoscopic hepatectomy, laparoscopic liver resection, robotic hepatectomy, robotic liver resection, Singapore

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Assessment of applicability of laparoscopic liver resection after previous abdominal surgery

Laparoscopic Surgery ◽

10.21037/ls.2018.09.04 ◽

2018 ◽

Vol 2 ◽

pp. 45-45

Author(s):

Lavanya Yohanathan ◽

Sean Cleary

Keyword(s):

Liver Resection ◽

Abdominal Surgery ◽

Laparoscopic Liver Resection ◽

Previous Abdominal Surgery

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Impact of Intraoperative Gravity-Dependent Atelectasis Following Laparoscopic Liver Resection Performed in the Lateral Position

10.21203/rs.3.rs-683021/v1 ◽

2021 ◽

Author(s):

Ryoichi Miyamoto ◽

Toshiro Ogura ◽

Amane Takahashi ◽

Akifumi Kimura ◽

Shinichi Matsudaira ◽

...

Keyword(s):

Risk Factors ◽

Liver Resection ◽

Postoperative Complications ◽

Laparoscopic Liver Resection ◽

Operating Time ◽

Multivariate Logistic Regression Analysis ◽

Lateral Position ◽

Cancer Center ◽

Related Factors ◽

Left Half

Abstract Purpose Laparoscopic liver resection (LLR) is currently an accepted approach for liver surgery in select patients. The correlation between the intraoperative position and the presence of gravity-dependent atelectasis (GDA) has been well discussed. However, LLR is performed in the left half lateral position, and the relationship between this position and the presence of GDA remains unclear. We evaluated the extent to which the intraoperative left half lateral position affects the presence of GDA. Furthermore, univariate and multivariate analyses were performed to identify potential risk factors for LLR postoperative complications with a special emphasis on the presence of GDA by comparing various patient-, liver- and surgery-related factors in a retrospective cohort. Methods We retrospectively evaluated 129 patients who underwent LLR in the left half lateral position at the Saitama Cancer Center in Saitama, Japan between March 2011 and July 2020. The frequency and duration of GDA were investigated. We divided the cohort into with GDA and without GDA groups based on a cutoff value (≥ 5 days, n = 61 and < 5 days, n = 68, respectively). Using multivariate analysis, the duration of GDA and several risk factors for LLR postoperative complications were independently assessed. Results Postoperative GDA was observed in 61 patients (47%) and lasted for 1 to 8 days in these patients. The mean duration of GDA was 4.3 days. Multivariate logistic regression analysis revealed a GDA duration of 5 days or more (odds ratio [OR], 2.03; p = 0.001) and an operating time > 388 minutes (OR, 5.31; p < 0.001) to be independent risk factors for LLR postoperative complications. Conclusions The incidence and duration of postoperative GDA are considered useful predictors of postoperative complications, and these predictors should be assessed to improve the short-term outcomes of patients undergoing LLR.

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Risk factors of open conversion in laparoscopic liver resection – a single center study

HPB ◽

10.1016/j.hpb.2016.02.600 ◽

2016 ◽

Vol 18 ◽

pp. e240

Author(s):

W. Cho ◽

C.H. Kwon ◽

J.W. Joh ◽

S.J. Kim ◽

G.S. Choi ◽

...

Keyword(s):

Risk Factors ◽

Liver Resection ◽

Laparoscopic Liver Resection ◽

Single Center ◽

Open Conversion ◽

Single Center Study ◽

Center Study

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Multivariate analysis of preoperative risk factors for prolonged operating time in laparoscopic liver resection

HPB ◽

10.1016/j.hpb.2019.10.1275 ◽

2019 ◽

Vol 21 ◽

pp. S973-S974

Author(s):

A. Sultana ◽

R.P. Sutcliffe ◽

K.J. Roberts ◽

P. Muiesan ◽

P. Nightingale ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Liver Resection ◽

Laparoscopic Liver Resection ◽

Operating Time ◽

Preoperative Risk ◽

Preoperative Risk Factors

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Laparoscopic Liver Resection in Patients with a History of Upper Abdominal Surgery

World Journal of Surgery ◽

10.1007/s00268-011-1073-z ◽

2011 ◽

Vol 35 (6) ◽

pp. 1333-1339 ◽

Cited By ~ 25

Author(s):

Keun Soo Ahn ◽

Ho-Seong Han ◽

Yoo-Seok Yoon ◽

Jai Young Cho ◽

Ji Hoon Kim

Keyword(s):

Liver Resection ◽

Abdominal Surgery ◽

Laparoscopic Liver Resection ◽

Upper Abdominal Surgery ◽

History Of ◽

Upper Abdominal

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Multivariate analysis of risk factors for postoperative complications after laparoscopic liver resection

Surgical Endoscopy ◽

10.1007/s00464-014-3965-0 ◽

2014 ◽

Vol 29 (9) ◽

pp. 2538-2544 ◽

Cited By ~ 20

Author(s):

Hadrien Tranchart ◽

Martin Gaillard ◽

Mircea Chirica ◽

Stefano Ferretti ◽

Gabriel Perlemuter ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Liver Resection ◽

Postoperative Complications ◽

Laparoscopic Liver Resection

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Patterns, timing, and predictors of recurrence after laparoscopic liver resection for hepatocellular carcinoma: results from a high-volume HPB center

Surgical Endoscopy ◽

10.1007/s00464-021-08390-5 ◽

2021 ◽

Author(s):

Haili Zhang ◽

Fei Liu ◽

Ningyuan Wen ◽

Bo Li ◽

Yonggang Wei

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Liver Resection ◽

Laparoscopic Liver Resection ◽

Survival Rates ◽

Surgical Margin ◽

Trocar Site ◽

Liver Recurrence ◽

Risk Factors For Recurrence ◽

Recurrence Patterns

Abstract Background Although long-term outcomes may be comparable between laparoscopic liver resection (LLR) and open liver resection (OLR) for hepatocellular carcinoma (HCC), there has been little discussion regarding the patterns of recurrence after LLR. Methods Patients with HCC who underwent hepatectomy between April 2015 and November 2018 were included in this study. The recurrence patterns were analyzed in detail. The recurrence outcomes following laparoscopic versus OLR for HCC were compared after 1:2 propensity score matching. Potential risk factors for recurrence were also assessed with Cox proportional risk models. Results Among 425 patients after LLR, 144 (33.8%) experienced recurrence at the last follow-up, with a median recurrence-free survival (RFS) of 10.0 months (range 1–58 months). The most frequent recurrence site was the liver (n = 99, 68.8%), followed by the surgical margin (n = 15, 10.4%) and distant metastases (n = 12, 8.3%). Liver recurrence with distant metastasis (n = 10, 6.9%) tended to occur early (median 8.0 months), while peritoneal recurrence (n = 8, 5.6%) occurred later (median 14.0 months). A total of 120 (83.3%) patients had recurrence within 2 years after LLR. No trocar site recurrence was observed in this study. The recurrence patterns, timing, and treatment did not show significant differences between the LLR and OLR. The independent risk factors for recurrence included ALBI grade, postoperative α-fetoprotein > 8 ng/ml, tumor size > 5 cm, surgical margin ≤ 1 cm, and multiple tumors. Patients with recurrence had 1- and 5-year overall survival rates of 81.1% and 60.7%, respectively, compared with rates of 95.8% and 92.9% for patients without recurrence (P < 0.000). Conclusion This study suggested that intrahepatic recurrence was still the most common recurrence pattern for HCC after LLR and that LLR did not increase the risk of trocar hole recurrence or implantation. Most cases of recurrence occurred within 2 years after LLR, suggesting that surveillance should be targeted to early recurrence.

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